Abstract
Colorectal cancer is associated with Infective Endocarditis (IE) due to specific gut pathogens, such as Streptococcus gallolyticus subspecies, that use tumor presence as a point of blood entry. However, the association between Streptococcus gallolyticus related IE and pre-cancerous colorectal lesions like dysplastic adenomas is unclear. Seventy-one patients diagnosed with IE who underwent colonoscopy in the extension study during admission were included in a clinical, microbiological and imaging follow-up, between January 2008 and December 2020. Pre-cancerous lesions were divided as high and low-grade dysplasia based on World Health Organization criteria. Colorectal cancer was defined as the presence of malignant cell beyond the muscularis mucosa. Twenty-two IE patients (31%) presented colorectal lesions: 8 (36%) colorectal cancer and 14 (64%) pre-cancerous lesions [14% high degree (n = 2); 86% low degree (n = 12)]. Both, colorectal cancer (25% Vs 2%; p = 0.007) and pre-neoplastic lesions (50% Vs 2%; p<0.001) were related with higher prevalence of IE caused by Streptococcus gallolyticus. Additionally, the subgroup of low grade pre-cancerous lesions also showed this association (50% Vs 2%; p<0.001). Pre-cancerous colorectal lesions are associated with Streptococcus gallolyticus IE. These results suggest that high and low degree colorectal lesions may also act as a gateway for gut pathogens.
Highlights
Infective Endocarditis (IE) due to gut pathogens presents a well-recognized relationship with Colorectal Cancer (CRC) (McCoy and Mason 3rd, 1951; Klein et al, 1977; Gupta et al, 2010; Darjee and Gibb, 1993)
Seventy-one patients with IE underwent to colonoscopy as a part of the extension analysis during hospitalization: 49 patients (69%) presented IE without colorectal lesions, 14 patients (20%) were IE with dysplastic adenomas and 8 patients (11%) were IE with CRC
CRC group (25% Vs 2%; p = 0.007) and pre-neoplastic lesions group (50% Vs 2%; p
Summary
Infective Endocarditis (IE) due to gut pathogens presents a well-recognized relationship with Colorectal Cancer (CRC) (McCoy and Mason 3rd, 1951; Klein et al, 1977; Gupta et al, 2010; Darjee and Gibb, 1993). 5-fold more CRC (Amado et al, 2015; Takamura et al, 2014) It is usually located in the colonic wall and it could benefit from the presence of a tumor and use these neoplastic sites as a point of entry to cause systemic infections (Boleij and Tjalsma, 2013). In the setting of Streptococcus gallolyticus IE, it is recommended to rule out occult CRC with colonoscopy during hospitalization (Schreuders et al, 2015; Habib et al, 2015).
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